title: Impact of concomitant coronary artery bypass grafting on in-hospital outcome in octogenarians undergoing aortic valve replacement.
abstract: OBJECTIVE
  Abundant data are available reporting excellent in-hospital outcomes after surgical aortic valve replacement (AVR) in octogenarians. However, there is a paucity of studies reporting the in-hospital outcome of concomitant AVR and coronary artery bypass grafting (CABG) in this group of patients. Hence, a comparison was made of the impact of concomitant AVR and CABG versus isolated AVR on in-hospital outcome in octogenarians.
  
  
  METHODS
  Between January 2001 and October 2011, a total of 114 consecutive octogenarians undergoing combined AVR and CABG were compared with a control group of octogenarians (n = 68) undergoing isolated AVR. A retrospective analysis was performed of a prospectively collected cardiac surgery database. In addition, the medical notes and charts of all study patients were reviewed.
  
  
  RESULTS
  The two groups had a similar mean age (AVR 82.3 +/- 2.4 years versus AVR + CABG 82.6 +/- 2.1 years; p = 0.91), demographics and EuroSCORE (AVR 11.4 versus AVR + CABG 13.2; p = 0.12). The aortic cross-clamp and cardiopulmonary bypass times were longer for AVR + CABG patients (p < 0.001). In-hospital mortality (7.4% after isolated AVR, 9.6% after AVR + CABG; p = 0.35 between groups) and major clinical outcomes for the two groups were found to be similar except for an increased need for hemofiltration in AVR + CABG patients (p = 0.02).
  
  
  CONCLUSIONS
  In-hospital outcomes for concomitant AVR and CABG in octogenarians are comparable to those of isolated AVR, justifying the performance of combined AVR and CABG in this high-risk group of carefully selected patients.
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom. drrajashahzad@hotmail.com
authors.forename: Shahzad G
authors.initials: SG
authors.lastname: Raja
authors.forename: Manoraj
authors.initials: M
authors.lastname: Navaratnarajah
authors.forename: Mubassher
authors.initials: M
authors.lastname: Husain
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Walker
authors.forename: Charles D
authors.initials: CD
authors.lastname: Ilsley
authors.forename: Toufan T
authors.initials: TT
authors.lastname: Bahrami
authors.forename: Julien A
authors.initials: JA
authors.lastname: Gaer
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
mesh_terms: D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome